A 78-year-old woman presents to the office with her daughter. Last week, she fell twice while she was walking with her daughter. She was not shaking or lost her consciousness and she got up in a minute. Her medical history is significant for hypertension and osteoarthritis. She takes Lisinopril daily and ibuprofen as needed. She also takes diphenhydramine to help her sleeping during the night. Her vital signs are within normal limits on sitting and standing. All her laboratory tests are within normal ranges. Her mini-mental status test is normal.
What is the best explanation for this patient’s fallings?
A – Alzheimer’s disease
B – Old age
C – Osteoarthritis
D – Postural hypotension
E – Side effect of one of her medications
One of the concerning side effects of diphenhydramine is dizziness and disturbed coordination which leads to multiple falls. Other choices are excluded by history, examination and normal laboratory tests. Old age does not result in falls unless there is accompanied illness.
The correct answer is E
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